三亚地区医院肠杆菌科细菌分子流行病学研究
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摘要
目的探讨三亚地区医院耐碳青霉烯类抗菌药物的肠杆菌科细菌(CRE)的耐药性及耐药基因的携带情况。方法收集医院2014年1月-2018年1月临床分离的肠杆菌科细菌标本1 699份,并对其中复苏成功的29株CRE和2株多药耐药鲍氏不动杆菌(MDR-AB)用改良Hodge试验(MHT)检测碳青霉烯酶,采用聚合酶链反应(PCR)法检测耐药基因NDM-1、KPC-2,并对扩增产物进行测序确认。结果 1 699株肠杆菌中共检出CRE50株,检出率为2.94%。CRE对阿米卡星耐药率较低为38.00%,对其他临床常用抗菌药物均表现出较高的耐药率(≥50.00%)。所研究的29株CRE中2株MHT试验阳性,阳性率为6.90%;26株扩增出碳青霉烯酶基因,检出率89.66%,其中21株携带NDM-1、11株携带KPC-2,6株同时具有NDM-1和KPC-2基因。1株MDR-AB同时含有NDM-1和KPC-2基因。结论医院检出CRE菌株所携带耐药基因以NDM-1为主,本地区的耐药菌流行具有热带地区的特点,具有一定的临床意义。
OBJECTIVE To investigate the distribution,antibiotics resistance and the resistance genes carriage of carbapenem-resistant Enterobacteriaceae(CRE)in a tropic hospital,and to provide appropriate instructions for clinical antibiotics usage so as to control the emergence of drug-resistant strains.METHODS A total of 1 699 samples of Enterobacteriaceae were collected from our hospitalduring Jan. 2014 to Jan. 2018.Among them,29 strains of CRE were recovered successfully.We examined carbapenemases in the 29 CRE,together with 2 multidrug-resistant Acinetobacter baumannii(MDR-AB)strains,by Modified Hodge Test(MHT).Polymerase chain reaction(PCR)was used for detection of resistance genes NDM-1 and KPC-2.The amplified products were further confirmed by nucleic acid sequencing.RESULTS A total of 50 CRE strains were detected in 1699 strains of Enterobacter,and the detection rate was 2.94%.CRE had a low resistance rate to amikacin,which was 38.00%.The resistance rates to the other antibiotics were higher(≥50.00%).Among the 29 CRE tested,2 were MHT tests positive(2/29,6.90%),and 26 strains were carbapenemase genes positive(89.66%).Among them,21 strains carried NDM-1 and 11 strain carried KPC-2,and 6 strains had both NDM-1 and KPC-2 genes.One MDR-AB strain was both NDM-1 and KPC-2 gene positive.CONCLUSIONThe drug-resistant genes carried by CRE strains in the hospital were mainly NDM-1.Our results showed that the epidemiologic expression of CRE has characteristics of tropic area,which has certain clinical significance.
OBJECTIVE To investigate the distribution,antibiotics resistance and the resistance genes carriage of carbapenem-resistant Enterobacteriaceae(CRE)in a tropic hospital,and to provide appropriate instructions for clinical antibiotics usage so as to control the emergence of drug-resistant strains.METHODS A total of 1 699 samples of Enterobacteriaceae were collected from our hospitalduring Jan. 2014 to Jan. 2018.Among them,29 strains of CRE were recovered successfully.We examined carbapenemases in the 29 CRE,together with 2 multidrug-resistant Acinetobacter baumannii(MDR-AB)strains,by Modified Hodge Test(MHT).Polymerase chain reaction(PCR)was used for detection of resistance genes NDM-1 and KPC-2.The amplified products were further confirmed by nucleic acid sequencing.RESULTS A total of 50 CRE strains were detected in 1699 strains of Enterobacter,and the detection rate was 2.94%.CRE had a low resistance rate to amikacin,which was 38.00%.The resistance rates to the other antibiotics were higher(≥50.00%).Among the 29 CRE tested,2 were MHT tests positive(2/29,6.90%),and 26 strains were carbapenemase genes positive(89.66%).Among them,21 strains carried NDM-1 and 11 strain carried KPC-2,and 6 strains had both NDM-1 and KPC-2 genes.One MDR-AB strain was both NDM-1 and KPC-2 gene positive.CONCLUSIONThe drug-resistant genes carried by CRE strains in the hospital were mainly NDM-1.Our results showed that the epidemiologic expression of CRE has characteristics of tropic area,which has certain clinical significance.
引文
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[6]叶丽艳,马艳宁,沈跃云,等.2008-2016年某医院耐碳青霉烯肠杆菌分布和药物敏感性分析[J].中国抗生素杂志,2017,42(5):408-412.
[7]孙佟,索继江,匡慧慧,等.新建医院临床分离菌株的分子流行病学研究[J].中华医院感染学杂志,2017,27(2):309-312.
[8]Deshpande P,Rodrigues C,Shetty A,et al.New Delhi Metallo-betalactam ase(NDM-1)in Enterobacteriaceae:treatment options with carbapenems com promised[J].J Assoc Physicians India,2010,58:147-149.
[9]Lee GC,Burgess DS.Treatment of Klebsiella pneumoniaec carbapen-emase(KPC)infections:a review of published case series and case reports[J].Ann Clin Microbiol Antim icrob,2012,11:32.
[10]张冀霞,王占伟,王启,等.替加环素对临床常见多重耐药菌的体外抗菌活性研究[J].中华检验医学杂志,2013,36(4):308-312.
[11]Shahcheraghi F,Nobari S,Rahmati ghezelgeh F,et al.First report of New Delhi metallo-beta-lactamase-1-producing Klebsiella pneumoniae in Iran[J].Microb Druq Resist,2013,19(1):30-36.
[12]王盛书,孙金柱,陈伟,等.我国携带KPC基因耐药菌流行现况分析[J].军事医学,2016,40(6):491-501.
[13]张冀霞,刘颖梅,陈宏斌,等.我国产碳青霉烯酶肠杆菌科细菌的基因型及流行病学研究[J].中华内科杂志,2014,53(2):116-120.
[14]Kazi M,Drego L,Nikam C,et al.Molecular characterization of carbapenem-resistant Enterobacteriaceae at a tertiary care laboratory in Mumbai[J].Eur J Clin Microbiol Infect Dis,2015,34(3):467-472.
[2]World Health Organization.WHO publishes list of bacteria for which new antibiotics are urgently needed[EB/OL].[2017-2-28]
[3]CLSI,2014.Performance standards for antimicrobial susceptibility testing;Twenty-fourth informational supplement[S].CLSI document M100-S24.
[4]Manenzhe RI,Zar HJ,Nicol MP,et al.The spread of carbapenemase-producing bacteria in Africa:a systematic review[J].J Antimicrob Chemother,2015,70(1):23-40.
[5]Lee C R,Lee J H,Park K S,et al.Global dissemination of carbapenemase-producing Klebsiella pneumoniae:epidemiology,genetic context,treatment options,and detection methods[J].Front Microbiol,2016,7(DM01):895.
[6]叶丽艳,马艳宁,沈跃云,等.2008-2016年某医院耐碳青霉烯肠杆菌分布和药物敏感性分析[J].中国抗生素杂志,2017,42(5):408-412.
[7]孙佟,索继江,匡慧慧,等.新建医院临床分离菌株的分子流行病学研究[J].中华医院感染学杂志,2017,27(2):309-312.
[8]Deshpande P,Rodrigues C,Shetty A,et al.New Delhi Metallo-betalactam ase(NDM-1)in Enterobacteriaceae:treatment options with carbapenems com promised[J].J Assoc Physicians India,2010,58:147-149.
[9]Lee GC,Burgess DS.Treatment of Klebsiella pneumoniaec carbapen-emase(KPC)infections:a review of published case series and case reports[J].Ann Clin Microbiol Antim icrob,2012,11:32.
[10]张冀霞,王占伟,王启,等.替加环素对临床常见多重耐药菌的体外抗菌活性研究[J].中华检验医学杂志,2013,36(4):308-312.
[11]Shahcheraghi F,Nobari S,Rahmati ghezelgeh F,et al.First report of New Delhi metallo-beta-lactamase-1-producing Klebsiella pneumoniae in Iran[J].Microb Druq Resist,2013,19(1):30-36.
[12]王盛书,孙金柱,陈伟,等.我国携带KPC基因耐药菌流行现况分析[J].军事医学,2016,40(6):491-501.
[13]张冀霞,刘颖梅,陈宏斌,等.我国产碳青霉烯酶肠杆菌科细菌的基因型及流行病学研究[J].中华内科杂志,2014,53(2):116-120.
[14]Kazi M,Drego L,Nikam C,et al.Molecular characterization of carbapenem-resistant Enterobacteriaceae at a tertiary care laboratory in Mumbai[J].Eur J Clin Microbiol Infect Dis,2015,34(3):467-472.